RECURRENT SEPSIS IN A PATIENT WITH BILIARY HAMARTOMAS.

Biliary hamartomas or von Meyenburg complexes (VMCs) are hepatic tumour-like lesions related to congenital malformation of the ductal plate, and are part of the ciliopathy spectrum of disorders. The exact pathogenesis of VMCs is unclear and it remains controversial whether they have the potential for malignant transformation. Patients are often asymptomatic and VMCs are usually encountered as an incidental finding on imaging. We report a case of recurrent sepsis with an unidentified focus. It was later confirmed that biliary hamartomas were acting as a sanctuary for the persistent pathogenic agent. The authors hope to draw attention to the existence of this unusual focus of recurrent sepsis. LEARNING POINTS: Hepatobiliary sepsis is an unusual clinical presentation of biliary hamartomas.Clinicians should be aware of the infectious complications of these diffuse structural biliary ductal abnormalities.Early recognition of this atypical life-threatening clinical presentation is important for the prognosis.

Effectiveness of Different Physiotherapy Protocols in Children in the Intensive Care Unit: A Randomized Clinical Trial.

PURPOSE: This study aimed to investigate the effectiveness of different physical therapy protocols on the autonomic modulation of heart rate, time of invasive mechanical ventilation (IMV), and length of hospital stay. METHODS: This was a randomized clinical study with 20 children on IMV in an intensive care unit (ICU), between July 2018 and September 2019. The control group (n = 10) performed the hospital's physical therapy protocol and the experimental group (n = 10) performed the physical therapy protocol based on physical exercise. RESULTS: Higher values of heart rate variability were found in the experimental group, both in individual and intergroup analyses. There was a significant reduction in the time of IMV and ICU stay. CONCLUSION: There was an improvement in heart rate variability, reduced time on mechanical ventilation and length of stay in the ICU in individuals who performed the study protocol.

Gaucher Disease: One of the Few Causes of Massive Splenomegaly.

Gaucher disease (GD) is a rare, autosomal recessive genetic disease caused by deficiency of a lysosomal enzyme (glucocerebrosidase/ß-glucosidase) that leads to the accumulation of its substrate in lysosomal macrophages. GD remains rare and delayed diagnosis is common due its gradual onset. It is important to include this differential diagnosis in cases of massive splenomegaly and/or thrombocytopenia, in order to avoid potentially harmful splenectomy. This case report describes a 25-year-old female patient with a 10-year medical history of anaemia and thrombocytopenia, who presented with symptoms of haemorrhagic dyscrasia, pancytopenia and massive splenomegaly. The differential diagnosis of massive splenomegaly included several conditions which were considered but ruled out. Because of a lack of resources, the patient was forwarded to a reference centre where the diagnosis of GD was made. LEARNING POINTS: Many diseases are associated with splenomegaly but massive splenomegaly is seen in only a few conditions.While some causes of splenomegaly are obvious (malaria, infection), the aetiological diagnosis of splenomegaly may involve extensive history taking, serum testing and imaging studies.Infiltrative disorders such as Gaucher disease are a rare cause of splenomegaly and should be considered when other more common causes have been ruled out.The authors hope to raise awareness of this diagnosis in order to encourage early treatment.

Analysis of the influence of endometriosis on quality of life / Análise da influência da endometriose na qualidade de vida

Abstract Introduction: Endometriosis is a disorder that can significantly affect quality of life (QOL) and interfere in biological, psychological, social, marital and family aspects. Objective: To analyze the influence of endometriosis on the QOL of women diagnosed with the disease. Methods: The study was carried out from March to April 2018, with 10 volunteers from the Santa Casa de Misericórdia do Pará Foundation, with a clinical diagnosis of endometriosis. The Portuguese version of the endometriosis health profile questionnaire (EHP-30) was applied in order to assess QOL in women with this pathology. Results: The sociodemographic results revealed a predominance of women aged between 29 and 55 years, most of whom were married (6) and high school graduates (5). Seven of the ten volunteers had previous pregnancies. Of the aspects evaluated in the EHP-30, 79% of the items associated with pelvic pain in the core questionnaire were present in the participants. In other questionnaires, sexual life (82%) was the most affected index, followed by professional life (70%) and infertility (58.82%). Conclusion: The aspects of QOL most impacted by pelvic pain associated with endometriosis in the women evaluated were sexuality and professional life, leading to biopsychosocial trauma.

Resumo Introdução: A endometriose é um distúrbio que pode atingir amplamente a qualidade de vida (QV) e interferir no âmbito biológico, psicológico, social, marital e familiar. Objetivo: Analisar a influência da endometriose na QV de mulheres portadoras dessa patologia. Métodos: O estudo foi realizado no período de março a abril de 2018, com dez voluntárias da Fundação Santa Casa de Misericórdia do Pará, que apresentavam diagnóstico clínico de endometriose. Aplicou-se o Questionário de Qualidade de vida em Endometriose (EHP-30), versão em português, a fim de avaliar a QV em mulheres com endometriose. Resultados: Os resultados sociodemográficos mostra-ram uma predominância de mulheres com idade entre 29 e 55 anos, sendo a maioria casada (6) e com colegial completo (5). Sete das dez voluntárias tiveram gestações. Dentre os âmbitos avaliados pelo EHP-30, o questionário central de QV relacionado à dor pélvica teve 79% dos itens comprometendo as participantes. Nos demais questionários, a vida sexual (82%) foi o índice mais afetado, seguido da vida profissional (70%) e infertilidade (58,82%). Conclusão: Nas mulheres avaliadas, os aspectos da QV mais influenciados pela dor pélvica relacionada à endometriose foram a sexualidade e a vida profissional, acarretando prejuízos biopsicossociais.

Modulação autonômica da frequência cardíaca em crianças e jovens com paralisia cerebral / Autonomic heart rate modulation in children and youths with cerebral palsy

Introdução: A paralisia cerebral é uma doença que causa distúrbios neuromusculares, doenças cardiovasculares, além de distúrbios autonômicos e homeostáticos. Objetivo: Avaliar a modulação autonômica cardíaca de crianças e jovens com PC. Métodos: Estudo de delineamento transversal e observacional de carácter quantitativo. Foram coletados os intervalos R-R (IRR) do eletrocardiograma de 05 voluntários cadeirantes, com idade de 06 a 18 anos com PC através do cardiofrequencimetro Polar modelo V800®. Resultados: Idade média foi de 12,4 anos, ambos os gêneros, massa corpórea de 35,1 kg, estatura de 1,39 m e índice de massa corpórea 16,8 kg/m2 equivalente à desnutrição. Os dados apresentam a modulação autonômica cardíaca no domínio do tempo, as variáveis do desvio-padrão de todos os intervalos RR normais 60,0 ms, raiz-quadrada da média da soma dos quadrados das diferenças entre os IRR normais 60,3 ms, porcentagem dos IRR adjacentes maiores que 50 ms 16,1 % e no domínio da frequência a baixa frequência cardíaca (un) 55,7, a alta frequência cardíaca (un) 44,2, a razão da alta com a baixa frequência cardíaca 2,3. Conclusão: As crianças e adolescentes com paralisia cerebral têm uma baixa variabilidade da frequência cardíaca, com alta probabilidade de desenvolver doenças cardiovasculares, devido ao sedentarismo. (AU)

Introduction: Cerebral Palsy is a disease that causes neuromuscular disorders, cardiovascular diseases, in addition to disorders autonomic and homeostatic. Objective: To measure the cardiac autonomic modulation of children and young people with CP. Methods: Quantitative crosssectional and observational study. The electrocardiogram R-R intervals (IRR) were collected from 05 volunteers in wheelchairs, aged 6 to 18 years with CP through the cardiofrequencimeter Polar model V800®. Results: The average age is 12.4 years, both genders, body mass 35.1 kg, height 1.39 m and body mass index of 16.8 kg/m2 equivalent to malnutrition. The data show cardiac autonomic modulation in the time domain, the standard deviation variables of all normal RR intervals 60.0 ms, square root of the mean of the sum of squares of the differences between normal IRR 60.3 ms, percentage of adjacent IRR greater than 50 ms 16.1% and in the frequency domain, low heart rate (un) 55.7, high heart rate (un) 44.2, the ratio of discharge to low heart rate 2,3. Conclusion: Children and adolescents with cerebral palsy have a low heart rate variability, with a greater probability of developing cardiovascular diseases, due to sedentary lifestyle. (AU)

Aspectos epidemiológicos de pacientes vitimados de escalpelamento assistidos em um hospital referência na Região Amazônica / Epidemiological aspects of scalping victims attended at a hospital in the Amazon Region

Introdução: O escalpelamento é trauma que causa ferimentos e lesões por avulsão parcial ou total do couro cabeludo, provocado, principalmente, pelo contato acidental dos cabelos compridos com o eixo do motor comumente utilizado em embarcações da Região Amazônica. Objetivo: Analisar o perfil epidemiológico de pacientes internados vítimas de escalpelamento assistidos em um hospital de referência materno infantil da Região Amazônica. Métodos: Tratase de um estudo epidemiológico, transversal, retrospectivo, documental, quantitativo realizado em hospital de referência às vítimas de escalpelamento, atendidos no período de janeiro de 2016 a dezembro de 2018. Após triagem inicial dos prontuários, 40 se enquadraram nos critérios de inclusão. Resultados: Em relação aos dados sociodemográficos, constatou-se no total de prontuários a prevalência do sexo feminino (97,5%), sendo sua maioria proveniente da mesorregião do Marajó (47,5%), tendo como principal característica o escalpelamento total (65,0%) por eixo de motor (95,0%). Dentre as complicações encontradas, a infecção oriunda do escalpelamento apresentou percentual de 12,5% (<0,001). Em relação aos procedimentos cirúrgicos, com 17,5%, a reconstrução do pavilhão auricular e trepanação apresentaram maior relevância (<0,001). Conclusão: Pode-se observar que as vítimas de escalpelamento passam longos períodos em tratamento e acompanhamento, implicando em um longo processo de hospitalização sendo submetidas a diversas intervenções cirúrgicas operatórias reparadoras e plásticas. Além disso, a extensividade do tratamento pode causar traumas devido às alterações anatomofisiológicas craniofacial. (AU)

Introduction: Scalping is trauma that causes injuries due to partial or total avulsion of the scalp, caused mainly by the accidental contact of long hair with the motor shaft commonly used in vessels in the Amazon region. Objective: To analyze the epidemiological profile of scalpel victims assisted at a maternal and child referral hospital in the Amazon region. Methods: This is an epidemiological, cross-sectional, retrospective, documentary, quantitative study conducted in a referral hospital for scalpel victims, from January 2016 to December 2018. After initial screening of medical records, 40 patients met the inclusion criteria. Results: Regarding the sociodemographic data, the prevalence of females (97.5%) was found in all medical records, most of them coming from the mesoregion of Marajó (47.5%), having as main characteristic the total scalping (65.0%) per motor axis (95.0%). Among the complications found, the infection resulting from scalping presented a percentage of 12.5% (<0.001). Regarding the surgical procedures, with 17.5%, the reconstruction of the pinna and trepanning were more relevant (<0.001). Conclusion: Scalping victims spend long periods of treatment and follow-up, implying a long hospitalization process and undergoing various repair and plastic surgical interventions. In addition, the extensiveness of the treatment can cause trauma due to craniofacial and anatomophysiological changes. (AU)

Analysis of epidemiological profile and ventilator parameters of postpartum women submitted to mechanical ventilation guided by electrical impedance tomography / Análise de perfil epidemiológico e parâmetros ventilatórios de puérperas submetidas à ventilação mecânica por meio da tomografia por impedância elétrica

INTRODUCTION: Pregnancy-related diseases have aggravated the situation of postpartum women, who end up using Mechanical Ventilation (MV) when admitted to Intensive Care Units (ICU). Although MV has benefits, it is associated with deleterious effects that can be minimized with the use of Electrical Impedance Tomography (EIT). OBJECTIVE: The aim was to analyze the epidemiological profile and ventilatory parameters of mothers, which developed HELLP Syndrome, sepsis and/or Acute Respiratory Distress Syndrome (ARDS), under MV and monitored with EIT. METHODS: The study was observational, cross-sectional, retrospective and prospective conducted between March and September 2018, using data collection forms filled from the database and sociodemographic, obstetric and ventilatory records of postpartum women admitted to adult ICU. RESULTS: The sample consisted of 13 postpartum women, 8 with sepsis (61.5%), 7 with HELLP syndrome (53.8%) and 4 with ARDS (30.8%). Five patients (38.5%) evolved with more than one of these conditions. Regarding the ventilatory parameters evaluated, VT 378.9 (±103.9) mL were observed and mean values found for PEEP 9.8 (±1.9) cmH2O and driving pressure 11.1 (±1.4) cmH2O are below recommendations in the literature, predicting lower mortality and morbidity index. CONCLUSION: The relevance of the driving pressure assessment in the MV setting was demonstrated, a parameter assessed by the EIT and directly related to static lung compliance (Cstat), PEEP, VT and optimization of regional pulmonary ventilation. It is highlighted the need for future research with greater clinical significance regarding the profile of postpartum women about the increasingly frequent diseases in this population.

INTRODUÇÃO: As doenças relacionadas à gravidez tem agravado o quadro de puérperas, que acabam fazendo uso de Ventilação Mecânica (VM) quando internadas em Unidades de Terapia Intensiva (UTI). A VM, apesar de trazer benefícios, está associada a efeitos deletérios que podem ser minimizados com o uso da Tomografia por Impedância Elétrica (TIE). OBJETIVO: Analisar o perfil epidemiológico e parâmetros ventilatórios de puérperas que evoluíram com Síndrome HELLP, Sepse e/ou Síndrome do Desconforto Respiratório Agudo (SDRA), sob VM e monitoradas com a TIE. MÉTODOS: Estudo observacional, transversal retrospectivo e prospectivo, realizado entre março e setembro de 2018, por meio de fichas de coletas preenchidas a partir de banco de dados/prontuários sociodemográficos, obstétricos e ventilatórios de puérperas internadas em UTI. RESULTADOS: Amostra composta por 13 puérperas, oito com Sepse (61,5%), sete com Síndrome HELLP (53,8%) e quatro com SDRA (30,8%), demonstrando que cinco (38,5%) pacientes evoluíram com mais de uma dessas patologias. Acerca dos parâmetros ventilatórios avaliados, observou-se VT 378.9 (± 103.9) e que valores médios encontrados para PEEP 9.8 (±1.9) e driving pressure 11.1 (±1.4) estão abaixo dos preconizados pela literatura, predizendo menores índices de mortalidade e morbidade. CONCLUSÃO: Demonstrou-se relevância da avaliação de driving pressure no cenário da VM, parâmetro avaliado por meio da TIE e diretamente relacionado à Cst, PEEP, VT e otimização da ventilação pulmonar regional. Destaca-se a necessidade de pesquisas futuras que apresentem maiores significâncias clínicas voltadas ao perfil de puérperas em relação às doenças cada vez mais frequentes nesta população.

Efeitos da mobilização precoce em crianças com pneumonia associada à ventilação mecânica: efeitos sobre variáveis não lineares da variabilidade da frequência cardíaca / Effects of early mobilization in children with pneumonia associated with mechanical ventilation: effects on non-linear variables of variability of heart rate

A pesquisa teve como objetivo verificar os efeitos da mobilização precoce em crianças com pneumonia associada à ventilação mecânica (PAV) sobre variáveis não lineares da variabilidade da frequência cardíaca. Foi realizado um ensaio clínico, prospectivo, de caráter quantitativo realizado em 13 pacientes de ambos os gêneros, com idade média de 5±1,3 anos, com diagnóstico de PAV. O estudo foi aprovado pelo Comitê de Ética e Pesquisa da Fundação Santa Casa de Misericórdia do Pará, parecer 2.084.580 e registo no Clinical Trials NCT03343717. Os voluntários foram submetidos ao protocolo convencional do hospital que consistia em exercícios respiratórios que incluíam técnicas de manobras de higiene brônquica, técnicas de reexpansão pulmonar e técnicas de mobilização passiva acrescida do protocolo de mobilização precoce proposto pelos autores. Os pacientes receberam atendimento uma vez ao dia, durante 4 dias consecutivos a partir do quarto dia após internação. A análise da recorrência, assim como a DFA α1, não obtiveram resultados relevantes para o estudo, com p=0,812 e p=0,09, respectivamente. A variável determinismo apresentou resultado com nível de significância <0,05 quando comparadas as médias, sendo que os valores dos pós protocolo foram inferiores ao do pré protocolo, indicando uma melhora da modulação autonômica da frequência cardíaca. A DFA α2 quando analisada a curto prazo, de 4 a 11 intervalos, não apresentou alteração pelo exercício, entretanto, na análise a longo prazo apontou diferença significante entre o pré e o pós protocolo. Os valores do pré-protocolo foram maiores indicando uma melhora da modulação autonômica após o protocolo de MP. A obilização precoce quando aplicada a pacientes pediátricos, levou a melhora da modulação autonômica da frequência cardíaca, além de ser um recurso da fisioterapia seguro e aplicável nas UTIs....(AU)

The aim of the research was to verify the effects of early mobilization in children with pneumonia associated with mechanical ventilation (PAV) on the nonlinear variables of the Heart Rate Variability. A prospective, quantitative clinical trial was conducted in 13 patients of both genders, with a mean age of 3 ± 2.3 years, with a diagnosis of PAV. The study was approved by the Ethics and Research Committee of the FSCMP, assent 2,084,580 and registered in Clinical Trials NCT03343717. The volunteers were submitted to the conventional protocol of the hospital consisting of breathing exercises that included techniques of bronchial hygiene maneuvers, pulmonary reexpansion techniques and passive mobilization techniques plus the protocol of early mobilization proposed by the authors. Patients received care once a day for 4 consecutive days from the fourth day after admission. The recurrence analysis, as well as the DFA α1, did not obtain relevant results for the study, with p = 0.812 and p = 0.09, respectively. The deterministic variable presented a result with significance level <0.05 when compared to the means, and the values of the post protocol were lower than the pre-protocol, indicating an improvement in theautonomic heart rate modulation. The DFA α2 when analyzed in the short term, from 4 to 11 intervals, did not present alteration by the exercise, however, in the long term analysis it pointed out a significant difference between the pre and post protocol. The pre-protocol values were higher indicating an improvement of the autonomic modulation after the MP protocol. Early mobilization when applied to pediatric patients led to an improvement in autonomic heart rate modulation, as well as being a safe physiotherapy resource in the ICUs....(AU)

CANCROX: a cross-species cancer therapy database.

Cancer comprises a set of more than 200 diseases resulting from the uncontrolled growth of cells that invade tissues and organs, which can spread to other regions of the body. The types of cancer found in humans are also described in animal models, a fact that has raised the interest of the scientific community in comparative oncology studies. In this study, bioinformatics tools were used to implement a computational model that uses text mining and natural language processing to construct a reference database that relates human and canine genes potentially associated with cancer, defining genetic pathways and information about cancer and cancer therapies. The CANCROX reference database was constructed by processing the scientific literature and lists more than 1300 drugs and therapies used to treat cancer, in addition to over 10 000 combinations of these drugs, including 40 types of cancer. A user-friendly interface was developed that enables researchers to search for different types of information about therapies, drug combinations, genes and types of cancer. In addition, data visualization tools allow to explore and relate different drugs and therapies for the treatment of cancer, providing information for groups studying animal models, in this case the dog, as well as groups studying cancer in humans.

Avaliação e classificação da capacidade física aeróbia de atletas de basquetebol em cadeira de rodas / Evaluation and classification of the aerobic capacity of wheelchair basketball players / Evaluación y clasificación de la capacidad aeróbica de jugadores de baloncesto en silla de ruedas

Resumo Este estudo objetivou avaliar e classificar a capacidade física aeróbia (CFA) de atletas de basquetebol em cadeira de rodas (BCR). Foram avaliados 16 atletas de BCR (oito homens/oito mulheres), que tinham as seguintes características: idade (27,2 ± 7,4 anos); massa corporal (59,0 ± 13,5 kg); estatura (153,4 ± 21,3 cm); tempo de deficiência (20,3 ± 12,3 anos); tempo de prática esportiva (9,0 ± 6,9 anos). Todos passaram por avaliação antropométrica e da CFA por meio do teste de 12 minutos para cadeirantes. Após as análises, observou-se que o consumo máximo de oxigênio dos atletas foi de, em média, 36,0 ± 3,5 ml/kg/min. Na análise qualitativa, a maioria dos atletas (62,5%) apresentou classificação da CFA "Excelente" (p = 0,02). Logo, conclui-se que os atletas avaliados apresentaram CFA acima do esperado, a maioria teve a classificação "Excelente". Isso sugere que a prática regular de BCR produz adaptações sistêmicas importantes ao sistema cardiorrespiratório.

Abstract The aim of this study was to evaluate and classify the aerobic capacity (AC) of wheelchair basketball (WB) players. For that, 16 WB athletes (8 men / 8 women), which has the following characteristics: age (27.2 ± 7.4 years); body mass (59.0 ± 13.5 kg); Height (153.4 ± 21.3 cm); time of disability (20.3 ± 12.3 years); time of sports practice (9.0 ± 6.9 years). All of participants underwent for the anthropometric and AC variables assessment through the 12-minute aerobic test for wheelchair users. After the analysis, there was observed average maximal oxygen uptake of 36.0 ± 3.5 ml/kg/min. In the qualitative analysis, most of the athletes (62.5%) presented an "Excellent" AC classification (p = 0.02). Therefore, it is concluded that the athletes presented higher AC than expected, rated as "Excellent" for the most of these, suggesting that the regular practice of WB produces important systemic adaptations to the cardiorespiratory system.

Resumen El objetivo de este estudio fue evaluar y clasificar la capacidad aeróbica (CA) de jugadores de baloncesto en silla de ruedas (BSR). Para ello, se evaluó a 16 atletas de BCR (8 hombres/8 mujeres), que presentaban las siguientes características: edad (27,2 ± 7,4 años); masa corporal (59,0 ± 13,5 kg); (153,4 ± 21,3 cm); tiempo de deficiencia (20,3 ± 12,3 años); tiempo de práctica deportiva (9,0 ± 6,9 años). Todos pasaron por la evaluación de las variables antropométricas y de la CA según la prueba aeróbica de 12 minutos en silla de ruedas. Después del análisis, se observó que la absorción máxima de oxígeno de los atletas fue, por término medio, de 36,01 ± 3,47 ml/kg/min. En el análisis cualitativo, la mayoría de los atletas (62,5%) presentaron una clasificación de la CA «excelente¼ (p = 0,02). Por tanto, se concluye que los atletas evaluados presentan una CA mayor de lo esperado y en la mayoría de ellos se clasifica como «excelente¼, lo que sugiere que la práctica regular de BSR tendrá importantes ajustes sistémicos en el sistema cardiorrespiratorio.

LQFM030 reduced Ehrlich ascites tumor cell proliferation and VEGF levels.

AIMS: This study reports the biological properties of LQFM030 in vivo, a molecular simplification of the compound nutlin-1. MAIN METHODS: Ehrlich ascites tumor (EAT)-bearing mice were treated intraperitoneally with LQFM030 (50, 75 or 150mg/kg) for 10days to determine changes in ascites tumor volume, body weight, cytotoxicity and angiogenesis. Moreover, flow cytometric expression of p53 and p21 proteins and caspase-3/7, -8 and -9 activation were investigated in EAT cells from mice treated. Acute oral systemic toxicity potential of LQFM030 in mice was also investigated using an alternative method. KEY FINDINGS: Treatment of EAT-bearing mice with LQFM030 resulted in a marked decline in tumor cell proliferation and the vascular endothelial growth factor (VEGF) levels along with enhanced survival of the mice. Apoptotic tumor cell death was detected through p53 and p21 modulation and increase of caspase-3/7, -8 and -9 activity. LQFM030 also showed orally well tolerated, being classified in the UN GHS category 5 (LD50>2000-5000mg/Kg). SIGNIFICANCE: LQFM030 seems to be a promising antitumor candidate for combinatory therapy with typical cytotoxic compounds, reducing the toxicity burden while allowing a superior anticancer activity. Moreover, these data also open new perspectives for LQFM030 as an antiangiogenic agent for treatment of diseases involving VEGF overexpression.

Eugenia dysenterica DC. (Myrtaceae) exerts chemopreventive effects against hexavalent chromium-induced damage in vitro and in vivo.

CONTEXT: Eugenia dysenterica DC. (Myrtaceae) has been widely used in the folk medicine and it presents phytochemicals constituents associated to antioxidant properties. OBJECTIVE: The objective of this study was to investigate the protective effects of E. dysenterica leaf hydroalcoholic extract (EDE) in vitro and in vivo using AMJ2-C11 cells and Swiss mice exposed to hexavalent chromium [Cr(VI)], respectively. MATERIALS AND METHODS: AMJ2-C11 cells were pretreated with EDE and exposed to Cr(VI) to evaluate cytotoxicity and the pathways involved in the chemopreventive effects of the extract. Mice were daily pretreated with EDE and then exposed to Cr(VI). Survival analysis, histopathological examination and determination of Cr levels in biological tissues were carried out. RESULTS: In vitro studies showed that pretreatment of the AMJ2-C11 cells with EDE protected against the cytotoxicity and oxidative stress induced by Cr(VI). Consequently, the pretreatment with EDE reduced reactive oxygen species and apoptosis triggered by Cr(VI), probably by a marked antioxidant and chelating activities demonstrated by EDE. Regarding in vivo studies, pretreatment for 10 days with EDE increased survival of the mice exposed to Cr(VI). In addition, EDE prevented liver and kidney pathological damages, in parallel with reduction in chromium levels found in these organs and plasma. EDE also showed a marked antioxidant potential associated with the presence of polyphenols, especially flavonoids and tannins, as confirmed by HPLC-PDA. CONCLUSION: The study showed that EDE protects against Cr(VI)-induced damage in vitro and in vivo supporting further studies for the development of therapeutic products applied to prevent the damage induced by toxic metals, especially Cr(VI).

Curcuminoids from Curcuma longaL. reduced intestinal mucositis induced by 5-fluorouracil in mice: Bioadhesive, proliferative, anti-inflammatory and antioxidant effects.

INTRODUCTION: Intestinal mucositis is a frequent limiting factor in anticancer therapy and there is currently no broadly effective treatment targeted to cure this side effect. OBJECTIVE: This study aimed to evaluate the effects of a mucoadhesive formulation containing curcuminoids (MFC) from Curcuma longa L. on the pathogenesis of 5-fluorouracil (5-FU)-induced intestinal mucositis. METHODS: Three intraperitoneal 5-FU injections (200 mg/kg) were used to induce intestinal mucositis in adult Swiss male mice. Treatment was provided orally (MFC 3.75, 7.5 and 15 mg/kg), thirty minutes before 5-FU injections, daily until euthanasia. Duodenal samples were collected to perform morphometric and histopathological analysis, to investigate the expression of Ki-67, p53, Bax and Bcl-2 by immunohistochemistry, to evaluate neutrophil activity myeloperoxidase (MPO)-mediated and oxidative stress by malondialdehyde (MDA) determination. Mice body weight was assessed as well. RESULTS: As expected, 5-FU induced a significant weight loss (∼17%, P < 0.001), shortening in villi height (∼55.4%) and crypts depth (∼47%), and increased (∼64%) the histological severity score when compared to other groups (P < 0.05). These pathological changes were markedly alleviated by the three MFC treatment doses (P < 0.05), in special with the dose MFC 15 mg/kg. This dose also stimulated cell proliferation by ∼90% in the epithelial cells lining from villi and crypts (P < 0.05), reduced MPO levels and MDA formation by 60% and 44%, respectively (P < 0.05). CONCLUSIONS: Our data suggest the therapeutic potential of the formulation for treating intestinal mucositis in mice. Supplementary studies are underway searching for the elucidation of mechanisms involved in the protective effects of MFC in order to make this formulation a clinical tool for mucositis treatment.

Use of Bidens pilosa L. (Asteraceae) and Curcuma longa L. (Zingiberaceae) to treat intestinal mucositis in mice: Toxico-pharmacological evaluations.

INTRODUCTION: Several studies towards the development of an effective treatment for intestinal mucositis have been reported, since this condition represents a major problem in clinical oncology practice due to cytotoxic effects of chemotherapy. However standardized protocols and universally accepted treatment options are yet to be established. OBJECTIVES: Given above, this study evaluated the protective effects of a mucoadhesive formulation containing both Bidens pilosa L. (Asteraceae) (BP) and curcuminoids from Curcuma longa L. (Zingiberaceae) (CL) on intestinal mucositis induced by 5-fluoruoacil (5-FU) in mice. RESULTS: As expected, animals only treated with 5-FU (200 mg/kg) showed a significant reduction of 60.3 and 42.4% in villi and crypts size, respectively, when compared to control. On the other hand, the proposed therapeutic/prophylactic treatment with mucoadhesive formulations managed to reduce histopathologic changes in mice bearing mucositis, especially at 125 mg/kg BP + 15 mg/kg CL dose. The formulation promoted an increase of 275.5% and 148.7% for villi and crypts size, respectively. Moreover, chemotherapy-related weight loss was reduced by 7.4% following the treatment. In addition, an increase of 10 and 30.5% in red and white blood cells was observed when compared to 5-FU group. Furthermore, treatments with the mucoadhesive formulation containing BP/CL up modulated Ki-67 and Bcl-2 expression while reduced pro-apoptotic regulator Bax. The formulation also modulated inflammatory response triggered by 5-FU through reduction of 68% of myeloperoxidase activity and a 4-fold increase in anti-inflammatory IL-10 levels. In parallel, the oxidative stress via lipid peroxidation was reduced as indicated by decrease of 63% of malondialdehyde concentrations. Additionally, the new formulation presented low acute oral systemic toxicity, being classified in the category 5 (2000 mg/kg < LD50 < 5000 mg/kg) of the Globally Harmonized Classification System. CONCLUSIONS: This study showed an interesting potential of the mucoadhesive formulation of BP/CL for the treatment of 5-FU-induced intestinal mucositis. Given the perspectives for the development of a new medicine, clinical studies are in progress to better understand the protective effects of this innovative formulation in treating mucositis.

Caracterização dos Pacientes Internados em uma Enfermaria Pediátrica de um Hospital de Referência de Belém-PA / Characterization of Patients Admitted To a Pediatric Ward of a Referral Hospital in Belém-PA

Caracterizar os pacientes internados em enfermariapediátrica de um hospital de referência de Belém-PA, no anode 2012. Material e Métodos: estudo transversal quantitativo,onde foi avaliada uma amostra randomizada de 230prontuários de pacientes admitidos na enfermaria pediátricano ano de 2012. As variáveis do estudo foram: sexo, faixaetária, procedência, motivo da admissão, tempo e desfechoda internação, diagnósticos clínico e nutricional,oxigenoterapia e tratamento fisioterapêutico. Para análiseda significância foi utilizado o teste Qui-Quadrado (Aderência)do programa BioEstat 5.0, e o nível de significância adotadofoi p valor = 0,05 (5%). Resultados: a amostra constituiu-sede pacientes do sexo feminino (52,6%), com faixa etária de0 a 23 meses (43,5%), procedentes da região metropolitanade Belém (49,6%), sendo os diagnósticos clínicos maispresentes aqueles relacionados com os sistemas respiratório(29,6%) e renal (24,6%), apresentavam na admissão pesoadequado (50,9%). Cinquenta e seis pacientes receberamatendimento fisioterapêutico (24,3%), sendo de abordagemmotora e/ou respiratória, e os meios de administração deoxigênio mais utilizados foram o cateter nasal (42,9%) e amáscara de Venturi (39,3%). Foram encontrados 13diagnósticos listados como condições sensíveis à atençãoprimária. Conclusão: estes resultados revelaram ascaracterísticas dos pacientes internados nesta enfermariaque se mostrou de caráter predominantemente clínico, comtempo de internação curto, até 10 dias (56,1%), podendocontribuir no planejamento institucional e no direcionamentode ações voltadas à prevenção de agravos e a promoção dasaúde nesta população a nível regional e nacional...

To characterize the profile of patients admitted tothe pediatric ward of a referral hospital in Belém-PA, in 2012.Material and Methods: This was a quantitative crosssectionalstudy evaluating a random sample of 230 medicalrecords of patients admitted to a pediatric ward in the year2012. The variables studied were: sex, age, origin, admissionreason, hospitalization length and outcomes, clinical andnutritional diagnostics, oxygen therapy and physical therapy.The Chi-square test was used for data analysis on BioEstat5.0, with a 5% significance level. Results: The sampleconsisted of female patients (52.6%), aged 0-23 months(43.5%), from the metropolitan area of Belém (49.6%). Theyhad clinical diagnosis more frequently related to respiratory(29.6%) and renal systems (24.6%) and presented properweight on admission (50.9%). Fifty-six patients receivedphysical therapy (24.3%), with motor and/or respiratoryapproaches. Oxygen was administrated in most cases vianasal catheter (42.9%) or the Venturi mask (39.3%). A totalof 13 diagnoses were found as primary care sensitiveconditions. Conclusion: The results revealed thecharacteristics of patients admitted in this pediatric ward.There was a predominance of clinical character, with shorthospital stay – up to 10 days (56.1%). Our findings maycontribute to the institutional planning and directing of actionsaimed at disease prevention and health promotion in thispopulation at a regional and national level...

Hipotermia terapêutica após parada cardíaca: preditores de prognóstico / Therapeutic hypothermia after cardiac arrest: outcome predictors

Resumo Objetivo: A determinação do prognóstico de pacientes em coma após parada cardíaca tem implicações clínicas, éticas e sociais. Exame neurológico, marcadores de imagem e bioquímicos são ferramentas úteis e bem aceitas na previsão da recuperação. Com o advento da hipotermia terapêutica, tais informações devem de ser confirmadas. Neste estudo procurou-se determinar a validade de diferentes marcadores que podem ser utilizados na detecção de pacientes com mau prognóstico durante um protocolo de hipotermia. Métodos: Foram coletados prospectivamente os dados de pacientes adultos, internados após parada cardíaca em nossa unidade de terapia intensiva para realização de protocolo de hipotermia. Nosso intuito foi realizar um estudo descritivo e analítico para analisar a relação entre os dados clínicos, parâmetros neurofisiológicos, de imagem e bioquímicos, e o desfecho após 6 meses, conforme definido pela escala Cerebral Performance Categories (bom, se 1-2, e mau, se 3-5). Foi coletada uma amostra para determinação de neuroenolase após 72 horas. Os exames de imagem e neurofisiológicos foram realizados 24 horas após o período de reaquecimento. Resultados: Foram incluídos 67 pacientes, dos quais 12 tiveram evolução neurológica favorável. Fibrilação ventricular e atividade teta no eletroencefalograma se associaram a bom prognóstico. Pacientes submetidos a resfriamento mais rápido (tempo médio de 163 versus 312 minutos), com lesão cerebral causada por hipóxia/isquemia detectada na ressonância nuclear magnética ou níveis de neuroenolase superiores a 58ng/mL se associaram a desfecho neurológico desfavorável (p < 0,05). Conclusão: A presença de lesão cerebral causada por hipóxia/isquemia e de neuroenolase foram fortes preditores de má evolução neurológica. Apesar da crença de que atingir rapidamente a temperatura alvo da hipotermia melhora o prognóstico neurológico, nosso estudo demonstrou que este fator se associou a um aumento da mortalidade e a uma pior evolução neurológica.

ABSTRACT Objective: The determination of coma patient prognosis after cardiac arrest has clinical, ethical and social implications. Neurological examination, imaging and biochemical markers are helpful tools accepted as reliable in predicting recovery. With the advent of therapeutic hypothermia, these data need to be reconfirmed. In this study, we attempted to determine the validity of different markers, which can be used in the detection of patients with poor prognosis under hypothermia. Methods: Data from adult patients admitted to our intensive care unit for a hypothermia protocol after cardiac arrest were recorded prospectively to generate a descriptive and analytical study analyzing the relationship between clinical, neurophysiological, imaging and biochemical parameters with 6-month outcomes defined according to the Cerebral Performance Categories scale (good 1-2, poor 3-5). Neuron-specific enolase was collected at 72 hours. Imaging and neurophysiologic exams were carried out in the 24 hours after the rewarming period. Results: Sixty-seven patients were included in the study, of which 12 had good neurological outcomes. Ventricular fibrillation and electroencephalographic theta activity were associated with increased likelihood of survival and improved neurological outcomes. Patients who had more rapid cooling (mean time of 163 versus 312 minutes), hypoxic-ischemic brain injury on magnetic resonance imaging or neuron-specific enolase > 58ng/mL had poor neurological outcomes (p < 0.05). Conclusion: Hypoxic-ischemic brain injury on magnetic resonance imaging and neuron-specific enolase were strong predictors of poor neurological outcomes. Although there is the belief that early achievement of target temperature improves neurological prognoses, in our study, there were increased mortality and worse neurological outcomes with earlier target-temperature achievement.

Doença de Pompe: manejo fisioterapêutico / Pompe disease: physical therapy management

Objetivo: revisar e descrever os atuais conceitos da Doença de Pompe, bem como, a fisiopatologia, métodosdiagnósticos, aspectos da função cardíaca, pulmonar, musculoesquelética e neurológica, novas terapêuticas e manejofisioterapêutico. Método: realizadarevisão da literatura científica com seleção das publicações sobre a Doença dePompe nos últimos 10 anos, em português e inglês. Considerações Finais: ao final da revisão percebeu-se quea história natural da Doença de Pompe vem sofrendo grandes mudanças graças o advento de terapias como a dereposição de enzimas, e que essa reposição, tem seu efeito acelerado com o manejo fisioterapêutico adequado

Objective:To review and describe the current concepts of Pompe disease, as well as its pathophysiology, diagnosticmethods, aspects of cardiac, pulmonary, musculoskeletal and neurologicalfunction, new therapies and physicaltherapy management. Method:A review of scientific literature was condutedwith selection of the publications aboutPompe disease in the last 10 years, in Portuguese and English. Conclusion: At the end of the review, it was noticedthat the natural history of Pompe disease has undergone great changes thanks to the advent of therapies, such asenzymesreplacement, and this replacement has its effect accelerated with the proper physical therapy management

Aspectos clínicos de recém-nascidos admitidos em unidade de terapia intensiva de hospital de referência da região norte do Brasil / Clinical aspects of newborns admitted in neonatal intensive care unit of the reference hospital in the northern region from Brazil

INTRODUÇÃO: O conhecimento das características de nascimento e óbitos de recém-nascidos, condições biológicas da gestação e parto, bem como dos neonatos admitidos em Unidades de Terapia Intensiva Neonatal (UTIN), disponibilizadas através de estudos epidemiológicos podem subsidiar ações de assistência em saúde materno-infantil, minimizando a ocorrência de agravos e planejando um atendimento mais adequado. OBJETIVO: Descrever os aspectos clínicos de recém-nascidos admitidos na UTIN de hospital de referência da região norte do país. MÉTODOS: Estudo transversal, descritivo e documental com amostragem aleatória simples composta por 318 prontuários de recém-nascidos admitidos na UTIN no ano de 2013,coletados por meio de ficha estruturada durante os meses de abrila julho de 2014. Foi realizada análise descritiva simples dos dados. RESULTADOS: A amostra constituiu-se de neonatos masculinos (53,14%),prematuros (92,14%) e de baixo peso ao nascimento (80,5%), com Apgar adequados no 1º e 5º minutos e sem utilizar surfactante pulmonar exógeno (54,72%). Suas genitoras constituíram-se de adultas jovens,com pré-natal inadequado (72,6%), partos cesarianos (56,0%), sem corticoterapia antenatal (91,19%) e provenientes do interior do estado (44,0%). Prematuridade foi a principal causa de admissão na Unidade (77,04%). Os neonatos necessitaram de suporte ventilatório, oxigenoterapia e assistência fisioterapêutica (92,14%). No total, 55% dos óbitos ocorreram precocemente, sendo o choque séptico a principal causa (40,83%). CONCLUSÃO: Estes resultados revelam as características dos recém-nascidos desta Unidade podendo contribuir no direcionamento de ações públicas voltadas à prevenção de agravos e a promoção da saúde materna e neonatal a nível regional e nacional.

INTRODUCTION: The knowledge of the characteristics of birth and newborn deaths, the biological conditions of pregnancy and delivery, as well as the neonates admitted to the Neonatal Intensive Care Unit (NICU), available through epidemiological studies can support care actions in maternal health and child, minimizing the occurrence of injuries and planning a more appropriate care. OBJECTIVE: To describe the clinical aspects of newborns admitted in the reference hospital's NICU in the northern region of the country. METHODS: Cross-sectional, descriptive and documentary study with a simple random sample composed of 318 medical records of newborns admitted in the NICU in 2013, collected through structured form during the months from April to July of 2014. It was performed the simple descriptive analysis of data. RESULTS: The sample consisted of male newborns (53.14%), premature (92.14%) and low birth weight (80.5%), with appropriate Apgarat 1st and 5th minutes and without using exogenous surfactant (54.72%). Their mothers consisted of young adults, with inadequate prenatal care (72.6%), cesarean deliveries (56.0%) without antenatal corticosteroids (91.19%) and from the interior of the state (44.0%). Prematurity was the main cause of admission to the unit (77.04%). Neonates required ventilatory support, oxygen therapy and physical therapy (92.14%). In total 55% ofthe deaths occurred early, being the main cause septic shock (40.83%). CONCLUSION: These results reveal the characteristics of newborns this unit which can contribute in directing public actions aimed at disease prevention and the promotion of maternal and newborn health at regional and national level.